The use of cutaneous or musculocutaneous flaps for total phalloplasty requires the lack of hairy skin; otherwise urethral strictures most likely will occur. A case of simultaneous total penile and urethral reconstruction using an expanded lateral arm sensory free flap is presented. The use of an expander in a small area of hairless skin on the lateral arm results in a free flap of sufficient size. This procedure proves to be a useful addition to the reconstructive armamentarium in dealing with similar challenging cases of penile reconstruction.
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